Provider Demographics
NPI:1952654261
Name:KIEFER, LAURA (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 YORKTOWN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1446
Mailing Address - Country:US
Mailing Address - Phone:574-971-8513
Mailing Address - Fax:
Practice Address - Street 1:505 W FOURTH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IN
Practice Address - Zip Code:46542-9310
Practice Address - Country:US
Practice Address - Phone:574-658-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004047A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant